Abstract W P160: Comparison of Arterial Stiffness and White Matter Hyperintensities according to Stroke Subtypes

Abstract

Introduction: Arterial stiffness, which can be measured by pulse wave velocity (PWV), is recognized as one of cardiovascular risk and may be directly involved in the process of atherosclerosis. White matter hyperintensities (WMHs) are receiving increasing attention as a risk factor for stroke and is associated with cognitive impairment, silent brain infarction (SBI), cerebral microbleeds, a poor functional outcome after stroke, and mortality. Hypertension, diabetes, age have been known as risk factors of arterial stiffness and WMHs. The hypothesis of our study is that marker of arterial stiffness and WMHs could have different values in different TOAST subtypes because each TOAST subtype has related to the different pathogenesis. Materials and Methods: We investigated all patients with a diagnosis of acute ischemic stroke admitted to the Department of Neurology at Gachon University Gil Medical Center between March 2012 and February 2013 retrospectively. The type of acute ischemic stroke was classified according to the TOAST classification. Carotid-femoral pulse wave velocity (PWV) was evaluated by Applanation tonometry (SphygmoCor) and WMHs are graded according to the Fazeka's and modified Fazeka's grading system. Results: We analyzed PWV, WMHs according to the TOAST in 230 patients with acute ischemic stroke. Lacunar subtype was significantly associated with hypertension, diabetes, and hyperlipidemia (p=0.040, p=0.005, p=0.016, respectively). PWV values, Fazeka's and modified Fazeka's grade in lacunar subtype were significantly higher compared to values observed in large artery atherosclerosis, cardio-embolic infarct, and stroke of other determined etiology subtypes (p=0.015, p=0.047, p=0.044, respectively). An increased PWV is significantly well correlated with the degree of WMHs. Discussion: Our study showed that hypertension, diabetes and hyperlipidemia were highly associated with lacunar subtype and arterial stiffness and WMHs in lacunar subtype are the highest among stroke subtypes. Therefore care of hypertension, diabetes and hyperlipidemia may be more important management in lacunar subtype than in other stroke subtypes.